Acute and Severe Hyperkalemia: Pathophysiological Approach

Abstract

Acute hyperkalemia with electrocardiogram (EKG) changes can be a life-threatening situation. Despite a large body of literature, the complex pathophysiology of hyperkalemia is not fully described or even explained at the molecular level in many textbooks. In this review, we specifically integrated a large body of clinical and experimental works describing how hyperkalemia impacts differently the cellular membrane potential in heart and muscle tissues. Integrating this knowledge appears relevant to the understanding of peculiar hyperkalemia-induced EKG changes that clinicians should be aware of. We discuss how some specific therapeutics (sodium salt infusion, in particular) might be reappraised in today’s practice. We also challenge the clinical relevance of isolated biological hyperkalemia. From a pathophysiological standpoint, we believe that hyperkalemia should be treated in regard to a specific clinical context more than based on potassium levels alone. This approach should be debated, especially in chronic renal failure patients. Clinical situations such as hyperkalemia occurring in patients with pacemaker devices, and hyperkalemia in preoperative settings are also discussed here.